| |||||||
| |||||||
| 1 | AMENDMENT TO HOUSE BILL 5313 | ||||||
| 2 | AMENDMENT NO. ______. Amend House Bill 5313 on page 2, by | ||||||
| 3 | replacing lines 8 through 17 with the following | ||||||
| 4 | "(3) The network plan shall, at least every 90 days, | ||||||
| 5 | audit periodically at least 25% of its provider | ||||||
| 6 | directories for accuracy, make any corrections necessary, | ||||||
| 7 | and retain documentation of the audit. The network plan | ||||||
| 8 | shall submit the audit to the Department, and the | ||||||
| 9 | Department shall make the audit publicly available | ||||||
| 10 | Director upon request. As part of these audits, the | ||||||
| 11 | network plan shall contact any provider in its network | ||||||
| 12 | that has not submitted a claim to the plan or otherwise | ||||||
| 13 | communicated his or her intent to continue participation | ||||||
| 14 | in the plan's network."; and | ||||||
| 15 | on page 9, by replacing lines 12 through 25 with the following: | ||||||
| 16 | "(215 ILCS 124/35 new) | ||||||
| |||||||
| |||||||
| 1 | Sec. 35. Complaint of incorrect charges. | ||||||
| 2 | (a) A beneficiary who incurs a cost for inappropriate | ||||||
| 3 | out-of-network charges for a provider, facility, or hospital | ||||||
| 4 | that was listed as in-network prior to the provision of | ||||||
| 5 | services may file a complaint with the Department. The | ||||||
| 6 | Department shall conduct an investigation of any complaint and | ||||||
| 7 | determine a complaint is sufficient if the beneficiary was | ||||||
| 8 | provided with inaccurate information by the network plan in | ||||||
| 9 | the directory. | ||||||
| 10 | (b) Upon a finding of sufficiency, a network plan shall | ||||||
| 11 | reimburse the beneficiary the amount necessary to ensure the | ||||||
| 12 | beneficiary is held harmless for all amounts exceeding the | ||||||
| 13 | amount the beneficiary would have paid had the services been | ||||||
| 14 | provided in-network. All out-of-pocket costs incurred by the | ||||||
| 15 | beneficiary shall apply toward the in-network deductible and | ||||||
| 16 | out-of-pocket maximum.". | ||||||